Incident Hepatitis C Cases Detected through a Custodial HCV Treatment Program

Author: Saulo D, Levy M, Kinner S, Hellard M, Snow K, Butler T

Theme: Epidemiology & Public Health Research Year: 2015

This project aimed to:
• describe an in-prison case series of suspected in prison acquired HCV infection;
• determine the strength of evidence for in-prison HCV transmission for each suspected case; and
• identify possible modes of transmission for each suspected case.

A mixed methods approach was taken, including both quantitative and qualitative interviews. Interviews were conducted at the prison facility with participants identified has having suspected in prison acquired HCV infection. Interviews determined risk behaviour and imprisonment timeframes related to blood exposure between the time of last HCV negative blood test and HCV positive test from March 2009 to May 2013.

Seven of 22 prisoners with suspected in prison acquired HCV consented to participate; six were classified as HCV in-prison incident cases. It was determined that none of the suspected prison acquired cases satisfied the criteria of the current national “newly acquired” HCV case definition. All six identified cases had a history of injecting drug use and reported at least one Epidemiology & Public Health Researchsode of sharing injecting equipment while in prison. Other potential exposures in prison included hair clippers, tattoos, fights, sport and, in one case a penile implant. Qualitative interviews shed light on prisoners’ perspectives of HCV; drug use while in prison; sharing of equipment and knowledge; and perceptions of HCV testing results.

We highlight the increased risk of exposure to blood while in prison, which, in the context of high HCV prevalence, indicates a need for evidence-based harm reduction measures, particularly needle and syringe programs and safer tattooing programs.

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